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Rural And Urban Disparities In European Health Insurance Access
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The Benefits And Burden Of Health Financing In Indonesia: Analyses Of Nationally Representative Cross Sectional Data
Received: 29 July 2022 / Revised: 21 September 2022 / Accepted: 30 September 2022 / Published: 4 October 2022
Providing access to various basic health services, community-based primary health care (CB-PHC) plays an important role in achieving health goals for all. Driven by a strong political commitment, China’s CB-PHC progress has been rapid and effective over the past decade. However, a well-functioning delivery system for care has yet to be established This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We searched five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. Eligible Papers We conducted our search and synthesis following the framework set out in Primary Health Care Performance (PHCPI). We synthesized the results of the included studies using thematic narrative methodology and reported them according to PRISMA guidelines. Six major barriers emerged from a synthesis of 67 papers: lack of comprehensive health insurance plans, lack of public awareness, redundant care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are divided into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A number of negative impacts of these restrictions on community-based health services were also identified Due to the lack of conceptual framework and research method limitations, it is not possible to determine the clear reasons for these barriers from the contributing evidence. China’s non-eastern regions and access barriers require further investigation According to research, the problems may be more severe at the national level.
As a whole-of-society approach, primary health care (PHC) addresses health needs throughout an individual’s lifespan, including health promotion, diagnosis, treatment, rehabilitation, and palliative care [ 1 ]. In 1978, the Alma-Ata Declaration committed to promoting PHC worldwide. Forty years later, the 2018 Astana Declaration reaffirmed the centrality of PHC in protecting human health. With its inclusive approach, PHC is seen as an essential reform in the healthcare system that will lead to high-quality universal health coverage. Following England, which pioneered PHC in the 1920 Dawson Report, other rich countries have made significant progress in establishing PHC systems. However, many low- and middle-income countries lag behind, hampered mainly by lack of human and financial resources. As the world’s most populous country with rapidly expanding global influence, China’s success in providing PHC services is critical not only for the health of its population but also for the newly industrialized economy seeking to emulate China’s PHC pattern. Figure 1 shows PHC providers in China
Extensive market-based reforms initiated in the late 1970s have led to internal migration and rapid urbanization in China on a scale unprecedented in human history . At the start of the reform, only 18% of China’s population lived in urban areas; China’s urban population has skyrocketed over the past four decades and now exceeds 900 million, accounting for more than 60% of its total population . Rapid urban population growth has placed greater pressure on healthcare infrastructure in urban China.
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Privatization reforms in the healthcare sector implemented between the mid-1980s and 1990s further weakened China’s healthcare system. Such privatization has been widely criticized for widening health shortages and health inequities As a result, the Chinese government began restructuring the country’s PHC system in 1997, particularly by developing community-based PHC (CB-PHC) in urban areas [ 9 ]. As a result, CB-PHC providers – community health centers and stations – have proliferated in towns and cities. Table 1 shows the major services provided by CB-PHC and non-CB-PHC organizations in urban China, indicating the breadth of services in CB-PHC settings.
The latest round of comprehensive health reforms, initiated in 2009, has further accelerated the development of CB-PHC in China. Certainly, the Chinese government has demonstrated its commitment to creating equitable, affordable, accessible, and high-quality CB-PHC services by enacting various policy directives and active public programs [ 11 , 12 ]. However, despite huge resource investment and subsequent appreciable progress, China has not yet developed an efficient CB-PHC system comparable to its Western counterparts such as the United States, the United Kingdom, and the Netherlands [ 13 , 14 ]. Unnecessary injections, inaccurate diagnoses, and inexperienced practitioners continue to characterize China’s CB-PHC organizations. Furthermore, complex neighborhood relationships and cryptic familiarity networks within communities undermine the standardization and professionalization of CB-PHC, ultimately undermining the quality of services. As a result, resident trust in CB-PHC remains low, and CB-PHC settings lack a trust-based care relationship. As an essential department of China’s public health system, CB-PHC plays the role of “gatekeeper” for the health of Chinese citizens. As the starting point for healthcare, it is crucial to promote population health, and its effectiveness and efficiency are important determinants of treatment outcomes at all levels. In China’s progressive public health system, CB-PHC is also responsible for monitoring, collecting and reporting local public health information under the direction of high-level medical institutions and government sectors. Therefore, a well-functioning CB-PHC system is needed to establish an effective public health system in urban China
To date, reviews of CB-PHC in China have focused primarily on quality issues, while barriers to delivery have been poorly synthesized. To present a comprehensive picture and serve as a reference for future research and policy development, this review synthesizes evidence from the literature on CB-PHC delivery in urban China, guided by two research questions: from the perspectives of service providers and users. , What are the barriers to CB-PHC delivery and what are the implications of barriers to community-based health care? Two research questions were formulated using the SPICE model, which are aligned with this review below: S/setting – urban China, P/perspective – CB-PHC service providers and users, I/event of interest – barriers. CB-PHC Delivery, C/Comparison – Not Applicable, and E/Evaluation – Impact of Restrictions on Community-Based Health Services. Compared to other frameworks employed to identify review questions in medicine and social sciences (eg, PICO, CIMO), the SPICE model is more appropriate for our review because it has two research characteristics – “setting” (missing in PICO) and “perspective”. (missing in CIMO) – which is essential for our search and synthesis The SPICE model, in fact, allowed us to frame the review questions more precisely
We synthesized selected evidence by systematic mapping Systematic mapping is an ideal method for collecting, describing and cataloging existing knowledge It is particularly useful for creating a classification scheme, structural clusters of interest, and mapping research trends Through a systematic mapping review, research gaps under a particular topic can be identified, as well as the need for empirical studies or further review of findings.
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We used the framework set out in Primary Health Care Performance (PHCPI) to guide our search and synthesis. The PHCPI framework was developed in collaboration with the Bill and Melinda Gates Foundation, the United Nations Children’s Fund, the World Bank Group, the World Health Organization, and Ariden Labs to simulate high-performance PHC systems in low- and middle-income countries. The PHCPI framework suggests four subdomains for evaluating the performance of PHC delivery: access, availability of effective care, people-centered care, and organization and management [ 23 ]. Given the number of existing reviews of Chinese quality
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